Registered Nurse, RN Transition Care Manager - Fort Worth, TX - $3,000 SIGN-ON BONUS! - Full-time / Part-time

$3,000 SIGN-ON BONUS!

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)

Be a part of a growing team!

Utilize your case management skills to improve the lives of patients.

The Transition Care Manager is responsible for utilization management and inpatient care management coordination and will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services by following medical guidelines and benefit determination.  They will also identify, screen, track, monitor and coordinate the care of members with multiple co-morbidities, psychosocial needs, transition needs and develop a nursing plan of care as well as prospective, concurrent, and retrospective utilization review of inpatient services. The Transition Care Manager acts as an advocate for members and their families  by linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward the maximum level of independence.  The Transition Care Manager is responsible for the case management activities across the continuum of care including coordination of care, medical management consulting and may also provide health education, coaching and treatment decision support for members.  The Transition Care Manager participates in interdisciplinary conferences and Patient Care Coordination Meeting (PCC) to review clinical assessments, update care plans and determine follow-up frequency with the team.

Primary Responsibilities:

• Collaborates effectively with interdisciplinary team (IDT) to establish an individualized plan of care for members.  The interdisciplinary care team Develops interventions to assist the member in meeting short and long term plan of care goals


• Serves as the clinical liaison with hospital, clinical and administrative staff as well as provides expertise for clinical authorizations for inpatient care based on utilized evidenced-based criteria


• Assess and evaluate new admissions and determines appropriate level of care based on evidenced-based criteria as well as monitors daily in-patient census for accuracy


• Stratifies and/or validates patient level of risk and communicates during transition process with IDT


• Provide assessments of physical, psycho-social and transition needs in settings not limited to the PCP office, hospital, or member's home.  Develops interventions and processes to assist the Health Plan and/or MSO member in meeting short and long term plan of care goals


• Coordinates and attends member visits with PCP and specialists as needed


• Manages assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process directly monitoring assigned members


• Provides constructive information to minimize problems and increase customer satisfaction


• Seeks ways to improve job efficiency and makes appropriate suggestions following the appropriate chain of command


• Demonstrates knowledge of utilization management and care coordination processes and current standards of care as a foundation for transition planning activities


• Confers with physician advisors on a regular basis regarding inpatient cases and participates in departmental utilization rounds.  Plans member transitions, with providers, patient and family


• Enters timely and accurate data into designated care management applications as needed to communicate patient needs and maintains audit scores of 90% or better on a quarterly basis


• Adheres to organizational and departmental policies and procedures and credentialed compliance


• Takes on-call assignment as directed


• Attends and Participates in interdisciplinary team meetings as directed


• Problem solving by gathering and /or reviewing facts and selecting the best solution from identified alternatives.  Decision-making is usually based on prior practice or policy, with some interpretation.  Must apply individual reasoning to the solution of problems, devising or modifying processes and writing procedures as necessary


• Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms


• With the assistance of the Managed Care/UM teams, guides physicians in their awareness of preferred contracts and providers and facilities


• Participates in the development of appropriate QI processes, establishing and monitoring indicators


• Performs all other related duties as assigned

Required Qualifications:

Preferred Qualifications:

• Experience working with psychiatric and geriatric patient populations


• Bilingual (English/Spanish) language proficiency

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Certain positions are subject to random drug testing.

Job Keywords: case manager, care manager, registered nurse, ccm, cm, RN, Fort Worth, TX, Texas, RN, Inpatient, Registered Nurse